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Rib Fractures
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Saharane posted:
I had a bump on my rib I found in early April. It was close to a chest tube scar so I thought nothing of it since I know I scar badly. My pcp was concerned and ordered an x-ray. The results are back. I have a fracture of the 8th and 9th rib. There has been NO trauma, to blows to the ribs, no car wrecks/fender benders.. Nothing! I was in absolute shock. There has been no pain to indicate they were broken. In August 2008 I had a bone density test done. The lady showed me I was border line and said it was good we caught it now before it became officially Osteoporosis. At my pcp's request I called and asked them to forward the results. when I told her why she said, "thats not unusual for someone with Osteoperosis" Then informed me the final decision on my scan was I had Osteoperosis!! This is the first I knew! Now my pcp is consulting with another MD. He had ordered a mamogram, and ct scan of the pelvis, abdomen, and chest. The hospital notified them, I am at 96% exposure to what a person can have in a 2 year period so now I can't have those tests done. I feel afraid, lost, and totally confused. He indicated, the fractures, especially with no trauma and no pain was not a good sign. I have also been battling Shingles in the last two weeks. I feel like I am loosing that battle also. Has anyone else broken bones and have no pain, bruising or even a bump? I mean the breaks are under the arm. Its not like you can bump into furniture or something. Ann
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bonebabe responded:
Hi Ann, I think I can clear up some of your confusion. It won't heal your fractures, but will give you info. First, let me explain about T-scores and the DXA scan. A T-score is an arbitrary number assigned to a DXA test in order to measure changes in the bone density. It doesn't stand for anything and it also is not a point of no return line. We tell our patients it would be like a number, say 180 lbs that was determined to be obese. If you were 6' tall and 180 lbs, you wouldn't be obese although you would be classified as that. Turn it around and if you're 5' tall and 180, you would be obese. We just have to have a measuring stick. That said, you can be classified as having low bone density (osteopenia) which is a T-score less than -2.5, and still fracture. There are no guarantees that you won't fracture simply because you don't have a clinical diagnosis of osteoporosis. Conversely, you can have osteoporosis and never fracture. You lose bone at different rates in different parts of the body. Because the ribs are small bones, as are the wrist bones, they would tend to lose density faster than your hip. A fracture such as yours is not uncommon at all in patients with low bone density. It's called a nontraumatic fracture and is a red flag. We have patients who have sneezed or squeezed and fractured a rib or vertebrae. This is the time now to consider pharmacological intervention if you haven't already talked to your doctor about it. The medical director of the osteoporosis center where I work recommends treatment if a T-score is lower than -2.0 or is lower than -1.5 with the presence of fractures. As for the radiation, I don't know what type you've had in the past two years, but a bone density test produces very little radiation - you'd have to have 32 chest x-rays to get the amount in one DXA - or just go thru airport security. Very little. Check out the National Osteoporosis Foundation website (www.nof.org) for a lot of good verified information. You can also order the booklet "Boning Up on Osteoporosis" from them. We use it as a teaching guide in our rehab and education classes. It will instruct you as to body mechanics and what moves are riskier for you and what aren't. Good info to have. In the meantime, you should know that having had one fracture doubles your risk for having another. So be sure to take 1200 mg of calcium each day (take them at meals for better absorption and several hours apart) and 1000 IU of Vitamin D. Try to spend at least 4 hours a day on your feet. A half hour walking each day is what we recommend. No forward bending at the waist. If you do yoga or pilates, I'd reconsider and look for some other form of exercise. I hope this helps you out some. If it prompts more questions, I'll try to answer those too. Beth
 
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Saharane responded:
ok, as far as the radiation. I had a growth in my lung and had a monthly ct scan with contrast from 6/07 to 1/08 until they removed the growth. (Non cancerous) also I have had a bone scan in Jan, and many chest x-rays and bone/back x rays since I have copd, spinal stenosis and spondylitis. My primary MD is consulting with a hemotalogist. That is confusing too. I go for the mamogram tomorrow. Oh I also had a chest x-ray for pre op on 30 March and they did say there are no rib fractures then. According to the nurse at my Primary's office. Its the hospital that classifys me at the 96% radiation exposure. I don't remember the exact numbers she gave me the day of my bone density results, but I can tell you the number was the last possible number before moving into the "osteopena" cattagory. THAT i do remember. That was the hip portion, the back portion the number was like one point better into the normal range. This I am sure of, because I have been taking calcium and vit d so it wouldn't get worse. That is also why I am confused how they could still classify me as osteoporosis. I fell down some stairs in June 2003 and shattered the large toe bone on my left foot. the end bone. It took three visits before the MD got it through my thick skull has to how severe the break was. He showed me bone dust where the bone disintegrated. He said if it had been any other bone in my body I would have required surgery. I had to wear a cast that extended beyond my foot for a month. It was not declared healed for almost two years. I had a spontaneous dissection MI 1/2007 and its been down hill ever since. In Feb 2007 I slipped on ice and broke the greater tuberousity and tore the rotator cuff muscle. This was all finally repaired May of 2008. Now I am also battling shingles. :crying: I will order the book as you recommend. Since my back surgery ( spinal stenosis) in April, I have had trouble standing up right. Some of it was habit from the severe pre surgery pain, some is the muscles don't seem to want to move. Because of cardiac issues I have walked daily since my MI, and I also work on my feet. I used to work 8 hours a day but I am currently still under post op restrictions of 4 hours a day. That will end soon. Thank you for your response and all advice is appreciated. Ann
 
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bonebabe responded:
Wow, you've had a lot going on. I do hope things are improving for you. If your T-score was one point before going into the osteopenia range, that would classify you as normal. Your back is not a valid area to test because of the stenosis. I would think the tech would've done a forearm on you. We do forearms when the back is compromised because it's the same type bone (trabecular) as is in the spine. We do not do followups on forearms because they don't respond to treatment well. Whether or not you're classified as anything, you've still had a nonviolent fracture. I would also guess that with the COPD you've taken steroids for greater than 12 weeks. They really do a number on the bones. Are you a smoker or prior smoker? That also contributes to bone loss. Calcium and Vit D are essential for maintaining good bone health but they do not guarantee a normal bone density. We don't know if you ever reached your peak bone mass either. Sometimes people with osteopenia/osteoporosis start losing bone from a peak mass that wasn't as high as it could've been due to poor dietary habits or medical conditions. With all you have going on, I'd still talk to the doctor about an osteoporosis medication regardless of T-scores. Both Fosamax and Actonel are approved for the prevention and treatment of osteoporosis. Get the booklet from the NOF. It should help tremendously. I think it's about $5. Ask again about those T-scores and next time ask for a forearm scan if they didn't do one. Beth
 
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Saharane responded:
They had me come in this morning for a cbc and two other blood tests I have never heard the names before. They said they are checking my liver function, kidney function and some other stuff. The hematologist he is consulting with wants these readings. I know my kidney numbers aren't good. They haven't been since my pulmonary MD put me on lasix. I will contact these people that did the bone density and see if I need to be put on medication. Meanwhile my Primary md does not think those T score numbers are enough to account for two "pathetic rib fractures" Thank you for your advice


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